Abstract
ObjectivesWe sought to determine the feasibility and reproducibility of real-time 3-dimensional echocardiography (RT3DE) for evaluation of cardiac volume, mass, and function and to characterize maturational changes of these measurements in human fetuses.MethodsEighty pregnant women in the 2nd and 3rd trimesters (59 with normal fetuses and 21 with fetuses with congenital heart disease [CHD]) were enrolled. We acquired RT3DE images using a matrix-array transducer. RT3DE measurements of volume, mass, stroke volume (SV), combined cardiac output (CCO), and ejection fraction (EF) were obtained. Images were scored and analyzed by two blinded independent observers. Inter- and intraobserver variabilities and correlations between fetal cardiac indices and gestational age were determined.ResultsFifty-two of 59 normal data sets (88%) and 9 of 21 CHD data sets (43%) were feasible for analysis. In normal fetuses, the right ventricle (RV) is larger than the left ventricle (LV) (P<0.05), but no difference exists between the LV and RV in mass, SV, CO, and CO/CCO. The EFs for the LV and RV were diminished; the RVSV/LVSV was reduced in CHD fetuses compared with normal fetuses (P<0.05). Fetal ventricular volumes, mass, SV, and CCO fit best into exponential curves with gestational age, but LVEF, RVEF, and RVSV/LVSV remain relatively constant.ConclusionsRT3DE is feasible and reproducible for assessment of LV and RV volume, mass, and function, especially in normal fetuses. Gestational growth of these measures, except for EF, is exponential in normal and CHD fetuses. CHD fetuses exhibit diminished LV and RV EFs.
Highlights
Ventricular volumetrics are crucial measures for evaluating fetal cardiovascular maturational growth, especially for fetuses with cardiac and extracardiac defects
Data reported that real-time 3-D echocardiography (RT3DE) based on matrix probe allows examination of fetal structures from multiple perspectives in real time, which is helpful to confirm normal cardiac structure and detect congenital anomalies [9,10,11,12,13], measurements of fetal ventricular volumes, mass, stroke volume (SV), combined cardiac output (CCO), and ejection fraction (EF) have not been systematically evaluated using matrix-array RT3DE
Study Subjects A total of 80 consecutive pregnant women using the perinatal services of the Oregon Health & Science University were enrolled in this study
Summary
Ventricular volumetrics are crucial measures for evaluating fetal cardiovascular maturational growth, especially for fetuses with cardiac and extracardiac defects. Accurate and reliable methods for assessing ventricular volumes, mass, stroke volume (SV), cardiac output (CO), and ejection fraction (EF) will provide information to guide medical and surgical management of fetuses with structural and functional abnormalities. Technological development in matrix-array and RT3DE allows acquisition of full-volume data sets within seconds in children and adults [8]. Data reported that RT3DE based on matrix probe allows examination of fetal structures from multiple perspectives in real time, which is helpful to confirm normal cardiac structure and detect congenital anomalies [9,10,11,12,13], measurements of fetal ventricular volumes, mass, SV, combined cardiac output (CCO), and EF have not been systematically evaluated using matrix-array RT3DE. The changing roles of the right and left ventricles during fetal growth and development warrant further investigation using a more reliable
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